HIV Linked to Rising Rates of Anal Cancer in Men
While anal cancer is rare, with less than 3,000 men diagnosed in 2017 according to the American Cancer Society, the rates have been rising in recent years. One of the main reasons for the increase is human papillomavirus infection. According to a national randomized study, Anal Cancer HSIL Outcomes Research, about 90 percent of anal cancers are caused by HPV. Thus, for HPV-infected men, anal cancer is becoming increasingly more common.
HIV Heightens Cancer Risk
Human immunodeficiency virus weakens the immune system overall, leaving infected people vulnerable to other viruses that may lead to cancer. In men especially, HIV is a leading cause of anal pre-cancer. When initial symptoms are left undetected or untreated, they can then lead to anal cancer.
Many studies have concluded that HIV or AIDS-infected patients are at a higher risk for certain types of cancer. In 2012, the National Cancer Institute released a statement that HIV infection is connected to rising anal cancer rates in men in the U.S. In 2016, the HIV/AIDS Cancer Match Study reported 1,225 cases of anal cancer in HIV-infected people. A study published in the November 2017 Journal of Clinical Oncology analyzed 447,953 HIV-infected people and found cancer incidence was higher than in the general population. Plus, the study reported the most cases of anal cancer were among men who have sex with men.
According to the national randomized study, ANCHOR, the anal cancer rates are highest in HIV-positive MSM. ANCHOR also estimates that one in 10 HIV-positive MSM will be diagnosed with anal cancer in their lifetime. The National LGBT Cancer Network reported that even HIV-negative MSM are an estimated 20 times more likely to get anal cancer, while HIV-positive MSM are 40 times more likely to be diagnosed with the disease.
Diagnosis and Treatment
The best practices for diagnosing and treating anal pre-cancer symptoms are still unclear, but efforts like ANCHOR continue to compare various methods. While a standardized, routine screening protocol does not yet exist, doctors should be prepared to detect abnormalities and symptoms in patients. In later stages of pre-cancer, patients may report pain when using the restroom or during intercourse. Providers should ideally provide HIV-positive men with an annual anal pap smear. With these examinations, doctors can look for any lumps, bleeding or hemorrhoids.
As HPV is a leading cause of the disease, safe sex practices, vaccinations and HIV treatment options may be the best ways to prevent anal cancer. Findings from a 2015 study published in Clinical Infections Diseases and a recent systematic review published in the JAMA Network showed that vaccinating those who have been diagnosed with pre-cancer may decrease the risk of anal cancer recurring after treatment. These post-treatment HPV vaccinations could decrease the number of treatments a patient needs and reduce any adverse outcomes or risks involved in surgery. Researchers are looking even further into these vaccines to determine whether they might be able to treat pre-cancer before it becomes fully-developed anal cancer.
Treating both HIV and cancer simultaneously can be complex, so it is important to coordinate treatments between experts on both diseases. With an already weakened immune system, HIV-infected cancer patients typically take anti-HIV drugs in addition to receiving standard forms of chemotherapy and radiation.
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